Coding and coverage · ICD-10-CM

S42

S42.2 Fracture of upper end of humerus

Not billable (header)Chapter 19

This code needs a 7th character (use X as a placeholder for missing characters).

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Codes under this one

  • S42.20 Unspecified fracture of upper end of humerusHeader
  • S42.21 Unspecified fracture of surgical neck of humerusHeader
  • S42.22 2-part fracture of surgical neck of humerusHeader
  • S42.23 3-part fracture of surgical neck of humerusHeader
  • S42.24 4-part fracture of surgical neck of humerusHeader
  • S42.25 Fracture of greater tuberosity of humerusHeader
  • S42.26 Fracture of lesser tuberosity of humerusHeader
  • S42.27 Torus fracture of upper end of humerusHeader
  • S42.29 Other fracture of upper end of humerusHeader

Instructional notes

Chapter 19

Excludes2Not included here: the patient may have both; report both when both are present.
Use additional codeAdd a second code for the full picture.
  • code to identify any retained foreign body, if applicable (Z18.-)
Notes
  • Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code
  • The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes.

Section S40-S49

Excludes2Not included here: the patient may have both; report both when both are present.
Includes
  • injuries of axilla
  • injuries of scapular region

S42

Excludes1Not coded here: never report with this code, except when the two conditions are unrelated.
  • traumatic amputation of shoulder and upper arm (S48.-)
Excludes2Not included here: the patient may have both; report both when both are present.
  • periprosthetic fracture around internal prosthetic shoulder joint (M97.3)
Notes
  • A fracture not indicated as displaced or nondisplaced should be coded to displaced
  • A fracture not indicated as open or closed should be coded to closed
7th charactersThe appropriate 7th character is to be added to all codes from category S42
  • A initial encounter for closed fracture
  • B initial encounter for open fracture
  • D subsequent encounter for fracture with routine healing
  • G subsequent encounter for fracture with delayed healing
  • K subsequent encounter for fracture with nonunion
  • P subsequent encounter for fracture with malunion
  • S sequela

This code

Excludes2Not included here: the patient may have both; report both when both are present.
  • fracture of shaft of humerus (S42.3-)
  • physeal fracture of upper end of humerus (S49.0-)
Inclusion terms
  • Fracture of proximal end of humerus

Chapter 19: Injury, poisoning and certain other consequences of external causes · S40-S49 Injuries to the shoulder and upper arm (S40-S49)

Source: ICD-10-CM FY 2027 code descriptions and tabular list (CMS and CDC National Center for Health Statistics), effective 2026-10-01 through 2027-09-30 · CMS ICD-10 files. HCC mapping: CMS-HCC V28, payment year 2027. As of 2026-11-04.

Coverage and payment depend on the claim details; confirm with the Medicare Administrative Contractor.